Tuesday, August 18, 2009

Hospital report

The latest news from the hospital is that they have scheduled a VATS for me tomorrow at a time to be determined. Since I won't be eating or drinking after midnight in the event that they can somehow squeeze me in as the day's very first case, I'm hoping someone's battery gives them trouble and they get here a scooch late. Otherwise, it could be a very long day.

This will be an actual surgery (albeit laproscopic) with real anesthesia, not that friendly sedative stuff. They will basically work the lung over in a variety of ways, including using talc and what sounds suspiciously like sandpaper to create scarring that will fuse the two layers of pleura that contain the lung together, theoretically making it impossible to collapse. More on that soon. They will remove the two tubes I got this week and insert a big surgical chest tube rather than the little 12 french "pigtails" we've been striking out with this month. Some combination of this work, we hope, will help the lung rise and stop leaking, at which point I will go home.

I don't remember clearly enough to have total confidence, but I'd say my expected stay here after the operation is about four days if all goes well. I've recovered well from this in the past, but it's no fun. It will be more difficult this time because the big, painful new tube is going into an area that is already banged up by the two tubes currently in place and the two-week old one they just removed. I plan to moan, whine and abuse any patient-controlled analgesia they provide. I will also sleep a lot.

That's the news. Here's a little noodling: In a display of good old fashioned surgical arrogance that I've only seen on TV, the doctor here seemed to feel that it would be literally impossible for the lung to collapse after he got through it. Given that I've had a pleurodesis three times and the lung has collapsed partially or mostly after every single one, sometimes disquietingly quickly, I sort of wish we had put down a bet on it. Fortunately, I liked the man and I think he has the chops to back up his confidence, even if he understandably isn't up-to-speed on just how intractable and infiltrative epithelioid sarcoma lung mets are. And, of course, I might of misunderstood what he was trying to say to me.

Let's stipulate I understood him correctly just for fun and think about the first two times I had VATS. (We won't count my first bedside pleurodesis.) I don't know anything about the guy here who did my first VATS other than he specializes in hearts (why don't they tell you that at the time?), but I feel strongly that Dr. Unpronounceable A at Sloan-Kettering was an exceptionally careful and competent physician. Everything from his big, prestigious job to his calm demeanor to his deliberate approach to my case to the incredible expertise, bedside manner and smoothness his chief intern showed when he put in a chest tube at my bedside convinced me. The chest tube I got in the emergency room here at home was like a scene from Saw; the work the young man did in NY was about as traumatic as Miles Davis, plus I got free instructions into how and where to flood the lidocaine for optimum pain control which will no doubt be useful as my career in thoracic surgery progresses. You can trust someone who teaches like that.